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Literature Review and Conceptual Framework View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by NORA - Norwegian Open Research Archives HEALTH SEEKING BEHAVIOUR IN ASIKUMA-ODOBEN- BRAKWA DISTRICT: A PLURALISTIC HEALTH PERSPECTIVE Prince Michael Amegbor Master thesis in Human Geography Department of Sociology and Human Geography University of Oslo May 2014 HEALTH SEEKING BEHAVIOUR IN ASIKUMA-ODOBEN- BRAKWA DISTRICT: A PLURALISTIC HEALTH PERSPECTIVE Prince Michael Amegbor Master thesis in Human Geography Department of Sociology and Human Geography University of Oslo May 2014 © Copyright by Prince Michael Amegbor 2014 All Rights Reserved ABSTRACT The phenomenon of health seeking behavior in the developing world has always been of interest to both researchers and policy makers. Over the years many academic and policy research have been done on this subject, however, these works have often failed to capture the health seeking behavior from a pluralistic health system perspective. Most works have concentrated on one health system at the neglect of the other when examining the health seeking behavior in the developing world. In the ones that have examined this phenomenon from both modern biomedicine and indigenous traditional medicine, the concept of spirituality and health has been totally ignored or given little attention. In light of this, the study sought to examine health seeking behavior in the Asikuma-Odoben- Brakwa district of Ghana from health pluralistic perspective giving attention to the issue of spirituality and health. The chosen study area is a predominantly rural district with few biomedical facilities thus helping to view the phenomenon from the angle of the rural, poor and vulnerable – a group that have been identified as most affected in the health care system of the developing world. A conceptual model of factors that determine health seeking behavior for both biomedicine and traditional medicine was developed based on a modified models of Aday and Andersen (1974) and Buor (2004) behavioral models of health care utilization. To appreciate the breadth and depth of this phenomenon, the study employed both quantitative and qualitative methods of research in soliciting for primary data from the field. The findings of this study revealed that despite various policies made to make biomedicine accessible to Ghanaians such as introduction of the National Health Insurance Scheme and Community Health Posts, majority of people in the study district still use self-treatment as their first choice in addressing their health needs. Although a vast majority would prefer using biomedicine to meet their health care needs, barriers such as finance and time prevent them from doing so. The preference for biomedicine was high compared to traditional medicine or self- treatment among respondents irrespective of their geographic location, gender, educational and economic background. Financial barrier was also seen as a challenge to access to traditional medicine, especially with the monetization and formal institutionalization of the practice. The study also revealed that the media plays an important role in the decisions and drugs people use for self-treatment; also family and social relations play a key role in determining the choice of treatment for terminal and sever ailments. The study also revealed a strong attachment among respondents and informant for spirituality and health irrespective of their socio-demographic background. Determining whether an ailment is spiritually caused comes through a complex process of social identification either by the patient or by a recognized healer. Patient often associated ailment with spiritual causation after failure of other remedies in healing and In the situation where the ailment comes after social dispute. Often, the choice of which type of healer used in addressing such ailment depends on 1 factors such as one’s religious orientation. The practice of buying substances from drug peddlers believed to have special powers to solve and heal spiritual infirmity is also another health seeking behavior exhibited by informants and respondents in meeting their spiritual health needs. 2 DEDICATION To My God and King – Jehovah Nissi, I could not have done this without you. 3 ACKNOWLEDGEMENTS I would like to express the deepest appreciation to my supervisor, Professor Jan Hesselberg, for his timeless guidance and mentorship during the period of my study at university of Oslo. After two years under your tutorship, i have improved in many ways as an academician and research; I am honored to have you as my supervisor. My profound gratitude also goes to Prof. Alex B. Asiedu, my mentor and academic god-father, for his encouragement and mentorship during my stay as undergraduate student in university of Ghana. Working under you during my national service period, afforded me the opportunity to learn a lot from you and tap into your genius mind. I thank the almighty for your life Prof. Asiedu, will always be grateful to you. My sincerest appreciation also goes to Dr. Joseph Teye of department of geography, university of Ghana. As a genius in academic research and research methods, I learnt a lot from your tutorship in quantitative research, which in many ways became very helpful in the conduct of this study. I also want to appreciate the staff the department of geography and resource development, University of Ghana such as Prof. Samuel Agyei-Mensah, Prof. J. Nabila, Prof. S. T. Addo and Prof. Songsore for the substance they added to my life during my undergraduate study. My deepest gratitude to Mr. Koomson and Mr. Isaac Ampah of Asikuma-Odoben-Brakwa district of Ghana, for their support during the conduct of the field studies; this study wouldn’t have been a success without your help. I also wish to thank my field research assistants who helped with the gathering of the quantitative data for this study; I am grateful for the good work you did. Last but not the least, to the lady of my life – Janet Anyorkor Marley – for all the love and support you gave me during my study. 4 TABLE OF CONTENTS Contents ABSTRACT ...................................................................................................................................................... 1 DEDICATION .................................................................................................................................................. 3 ACKNOWLEDGEMENTS ................................................................................................................................. 4 TABLE OF CONTENTS ..................................................................................................................................... 5 ABBREVIATIONS ............................................................................................................................................ 8 LIST OF TABLES .............................................................................................................................................. 9 LIST OF FIGURES .......................................................................................................................................... 11 CHAPTER 1 INTRODUCTION AND BACKGROUND OF STUDY ...................................................................... 12 1.1 Background of Study ......................................................................................................................... 12 1.2 Research Problem ............................................................................................................................. 13 1.3 Research Questions .......................................................................................................................... 15 1.4 Research Propositions and Hypotheses ............................................................................................ 15 1.5 Relevance of Research ...................................................................................................................... 16 CHAPTER 2 LITERATURE REVIEW AND CONCEPTUAL FRMAEWORK ...................................................... 18 2.1 Introduction: Review of Literature ................................................................................................... 18 2.1.1 Medical Pluralism and Global Patterns of Medical Pluralism .................................................... 21 2.1.2 Approaches to Medical Pluralism and Cooperation in the Developing World Societies ........... 23 2.1.3 Competing Paradigms of Modern Biomedical and Traditional Medical Systems ...................... 25 2.1.4 African Traditional Healing and Concept of Illness .................................................................... 28 2.1.5 The Traditional Healing Process and the Role of Faith in Healing ............................................. 31 2.1.6 Health Seeking Behavior: Approaches, Problem and Prospects in the Developing World ....... 35 2.2 Conceptual Framework - Model of Factors of Health Seeking Behavior/Utilization ........................ 40 2.3 Summary ........................................................................................................................................... 44 CHAPTER 3 STUDY AREA ......................................................................................................................... 45 3.1 Brief Profile and Demographics ........................................................................................................ 45 3.2 Level of Poverty in Asikuma-Odoben-Brakwa
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